Health Care Reform Is Worldwide Issue

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MU RESEARCHER SAYS HEALTH CARE REFORM IS WORLDWIDE ISSUE

COLUMBIA, Mo. -- Health care reform has gone global. Countries are looking at their own systems and others as they search for the best way to provide health care. Amid the confusion, a University of Missouri-Columbia professor is working hard to provide a framework for the pieces of this health care puzzle.

"Everywhere you look, countries are undergoing reform," said Andrew Twaddle, professor of sociology at MU. "We are seeing scores of people looking at different types of information. What we are trying to do is establish a framework so that people can see all of the information that is out there in context."

Twaddle, who recently presented the keynote address at a conference in Brisbane, Australia, on the future of general practice, has been researching the health care industry for about 35 years. Through his research, Twaddle has identified three systems of health care organization around the world: a democratic system, a professional system and a market system.

"These different systems do not exist in pure forms anywhere in the world," Twaddle said. "However, every country tends to lean toward one model more than the others."

In a democratic system, a group of elected officials and civil servants, who are accountable to the citizens of the country, make most of the decisions around the organization of health care. An example of this can be found in Sweden's health care system. Systems such as these favor equality, and regulation of the system is accomplished through elections and opposing political parties.

Professional systems are predominantly shaped by physicians, and a tendency toward effectiveness or quality is prevalent. Prior to 1994, Europe and the United States used professional systems. Supporters of these systems emphasize the enhancement of knowledge and technique. Peer pressure and ethical norms are the means of control within these systems.

Market systems are controlled by investor-owned, for-profit companies using competition as a way to control costs. Currently, this system is in use in the United States. Market systems focus on the value of efficiency, seeing regulation by competition as the most cost-effective way to distribute resources.

"More and more countries are looking toward market systems as the way of reform, but they do have drawbacks," Twaddle said. "If health care reform leans toward a market bias, two things will happen for general practitioners. There will be a move toward general practice medicine and away from specialists, and the general practitioners will have less control over what they do and how they do it. Moreover, markets have not demonstrated that they can control costs and maintain quality."

The models Twaddle used in his presentation came from his recently published book, Health Care Reform in Sweden, 1980-1994. Now, a group of researchers from around the globe led by Twaddle are carrying that research forward by publishing a book about system reforms in other countries.

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